Shirelle Latrice Clark, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

10003750 Issued in OR

Practice address

3303 S Bond Ave
Portland, OR 97239-4501

Phone

(503) 494-6594

Fax

(503) 494-5385

NPI assigned

Oct 29, 2018

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• City of Hope Medical Group of Georgia LLC

  • Internal Medicine Physician
  • Newnan, GA
  • NPI 1447520333
  Medicare reassignment NPD
• NSH Cancer Institute Professional Services a LLC

  • Hematology & Oncology Physician
  • Atlanta, GA
  • NPI 1215288378
  Medicare reassignment NPD
• NSH Cancer Institute Professional Services a LLC

  • Durable Medical Equipment & Medical Supplies
  • Decatur, GA
  • NPI 1750631792
  NPD
• Mid-Columbia Medical Center

  • Rural Health Clinic/Center
  • The Dalles, OR
  • NPI 1154351336

  Family

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1540771200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679356800000",
    "number": "1144797085",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 SW 5TH AVE STE 500",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972015537",
            "telephone_number": "866-617-6855",
            "fax_number": "503-346-8015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3303 S BOND AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972394501",
            "telephone_number": "503-494-6594",
            "fax_number": "503-494-5385"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1050 Eagles Landing Pkwy Ste 302",
            "address_purpose": "LOCATION",
            "city": "Stockbridge",
            "state": "GA",
            "postal_code": "302819250",
            "country_code": "US",
            "telephone_number": "678-723-1831",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "SHIRELLE",
        "middle_name": "LATRICE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-10-29",
        "last_updated": "2023-03-21",
        "certification_date": "2023-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OR",
            "license": "10003750",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN228546",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rebekah Clark
• Rhiannon C. Clark, PT, DPT
• Roger Kevin Clark Jr., PHARMD
• Sarah K Clark, L.AC.
• Scott Clark
• Tatum Natalee Clark
• Taylor Renee Clark
• Valentine Clark
• Veronica Rose Clark, CADC 1
• Wayne Marston Clark, MD

• Family Nurse Practitioner in Portland, OR
• Providers in Portland, OR by specialty
• Family Nurse Practitioner in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.